Prof Isaac Adewole, the Minister of Health, has faulted the deplorable state of tertiary health institutions in the country on the inability of state governors to fund basic primary and secondary health facilities under their respective care. On Tuesday, Adewole, who stated this at the Senate plenary, said state governments had “literally abandoned” health care. He also accused 14 states including Sokoto, Ogun, Cross River, Benue and Rivers of refusal to embrace the Basic Health Care Provision Fund which would have enabled them to access the N55.15bn earmarked for primary health care in the country. The National Assembly had earmarked N55.15bn in the 2018 budget as one per cent of the Consolidated Revenue Fund for the BHCPF.
Health experts have praised the National Assembly’s approval of the BHCPF in the 2018 Appropriation Act. Meanwhile to access the fund, state governments must deposit N100m in a dedicated account at the Central Bank as counterpart fund and must have their own health insurance scheme law among other conditions. Meanwhile Sokoto, Cross River, Ogun and Benue states said the Federal Government’s alleged politicisation of the health policy was responsible for their inability to access the fund. They argued that the choice of beneficiaries for the health care fund was allegedly skewed in favour of states in the good book of the Federal Government. Adewole explained, at the plenary, what his ministry was doing to address the terrible conditions of the Federal Government-owned teaching and specialist hospitals across the country.
The minister, who answered questions from the senators, however, said the inability of the state governments to pay adequate attention to health issues had overwhelmed the federal health institutions and the specialists there. He lamented that Nigerians no longer had confidence in the primary and secondary health care centres, hence their preference for tertiary facilities which were set up to take care of referral cases only. Adewole commended the federal lawmakers for approving the BHCPF which he described as a game changer in the nation’s health sector. He, however, regretted that about one year after the 2018 budget was signed into law, 14 states had yet to embrace the BHCPF which would have enabled them to access the N55.15bn earmarked for primary health care in the country.
The minister stated, “The states have literally abandoned healthcare such that everything is handled by the Federal Government. We cannot succeed with this. “What we have done through your support, and I must commend you for approving the healthcare basic fund, it is a game changer. We have spent almost a year developing the guidelines and over the last weeks, we have started a roll-out and as at the last count, 22 states have registered for the basic healthcare provision fund. “What we have done with the fund is to structure it in a way that money will flow from the Central Bank to the primary health care facilities bypassing all obstacles. Last week, we succeeded in moving out funds from the Central Bank to the agencies and from the agencies, it will go to the primary health care centres.
“As of today, 14 states are yet to show interest in the basic health care provision fund and because senators represent the entire country, I want to quickly seek your permission to list the 14 states that have yet to register – Kebbi, Jigawa, Akwa Ibom, Cross River, Gombe, Rivers, Borno, Zamfara, Ondo, Benue, Taraba, Nasarawa, Ogun and Sokoto. “It is unfortunate because this is a game changer. There will be free ante-natal care, free delivery, take care of malaria, screen for tuberculosis, hypertension and diabetes.” While also admitting that tertiary health institutions required adequate funding, Adewole said only the National Hospital, Abuja and the Lagos University Teaching Hospital had cancer treatment machines in the country.
He said the two hospitals had capacity to treat 300 cancer patients successfully every day. Adewole said, “If we invest in primary health care, people’s rush to seek treatment in tertiary health institutions will reduce. Only 22 states have so far registered for the BHCPF while 14 had yet to register.” Adewole said if all the states embraced the BHCPF initiative, the nation would be able to reach 10,000 places and over 100 million Nigerians with basic health care. The minister said for the country to come out of its current health crisis, the governors must without further delay, set up health care development agencies, institute the health insurance scheme and pay their counterpart fund of N100m to access the BHCPF.
He said the federal tertiary teaching health institutions were carrying out innovations including open heart surgery and separation of conjoined twins. Adewole told the senators that his ministry had commissioned a team of consultants to carry out a comprehensive diagnosis of all tertiary and teaching hospitals across the country with a view to identifying the real challenges facing them. The minister said the initiative would deliver basic health care services to all Nigerians through the primary health system. He said he had used the Nigeria Governors’ Forum and engaged in personal interactions with the defaulting governors on the need to key into the fund but to no avail.
The minister said the collapse of primary and secondary health care centres had led to patients visiting tertiary health institutions for ailments including headache, malaria and high blood pressure. He said Nigeria currently had 59 tertiary institutions which included 22 teaching hospitals, 20 Federal Medical Centres and 17 specialist hospitals. Adewole identified epileptic power supply and inadequate water supply as the major challenges consuming the funds allocated to the nation’s tertiary institutions. The Health minister was accompanied to the Senate by top officials of his ministry and chief medical directors of the various teaching hospitals across the country. He said the Federal Government through a former health minister; the late Dr Olikoye Ransome-Kuti, invested in the primary health care institutions but that the system collapsed after the exit of Gen. Ibrahim Babangida, the military dictator.
He said, “There were a series of complaints under (former President Olusegun) Obasanjo and he decided to invest heavily in tertiary health institutions to the detriment of primary and secondary health institutions which obviously collapsed due to poor funding. “The development overwhelmed the tertiary health institutions who started treating cases especially malaria instead of attending to referral cases.” Ahmad Lawan, the Senate Leader, urged the minister to use his good offices to talk to the governors to embrace the laudable effort made possible by the federal parliament. Also, Bala Ibn Na’Allah, the Deputy Leader, said the Federal Ministry of Health should dismantle bureaucratic bottlenecks preventing the citizens from accessing health care.
He urged the minister to ensure that no citizen was left behind in accessing health care. Senator Sam Egwu asked whether the minister was aware that some medical students were still roaming the streets because they had nowhere to carry out their housemanship before they could go for their youth service. The minister acknowledged the problem of inadequate placement for medical students but noted that the Federal Government had provided 4, 000 spaces. He encouraged affected medical graduates to contact his ministry to address the problem.
C’River, Benue, Sokoto, River accuse FG of politicization
But in their separate reactions, the Cross River, Benue, Sokoto and Rivers state governments accused the Federal Government of politicising the BHCPF. The Cross River State Government through the Permanent Secretary in the Ministry of Health, Dr Bassey Joseph, said it was not true that the state government was not showing interest in the BHCPF. He said, “We have applied for the fund. The requirement for accessing the fund is for each state to deposit N100m in a dedicated account with the Central Bank. Of course, you are aware of the state’s lean resources. Where do you expect the state to get that kind of money to deposit in order to access the fund? They are just playing politics with the fund.”
There is politics in accessing the fund — Benue commissioner
Also the Benue State Commissioner for Health, Dr Eru Emmanuel, said the state had started the process of accessing the fund. He, however, stated that the fund had been politicised. “There is politics in this thing. There are some states such as Katsina, Plateau and Osun that didn’t do more than we have done and they are already benefitting from the fund,” he stated. The commissioner, who spoke to one of our correspondents on the telephone, said the state government had started the process of accessing the fund. He stated, “I just met the governor and he has approved the names of the steering committee. We have written a letter of intent but the minister said that it must be signed by the governor. We have opened an account with the Central Bank of Nigeria.”
FG doesn’t look in Rivers’ direction –Commissioner
On his part, the Rivers State Commissioner for Information, Emma Okah, disagreed with the health minister, insisting that the state did not abandon the health sector. Okah explained the state government was popular for paying peculiar attention to the health sector. “The Governor Nyesom Wike administration renovated 13 general hospitals and it is building five zonal hospitals and paid relevant fees for those doing medical programmes in the state,” he added. He explained that the Federal Government had never looked at the direction of Rivers State whenever there was something for states in the country to benefit from. “I don’t have the exact details (on the Basic Health Care Fund), but what has the Federal Government given to us before? Everybody knows that we have been at the receiving end on many things that states are entitled to. “When it comes to things that the states are entitled to, hardly will they look at our direction. That is why we have taken our destiny in our hands and do our thing,” Okah added.
FG showing favouritism in fund disbursement – Sokoto commissioner
Also, the Sokoto State Commissioner for Health, Dr Mohammed Inname, alleged favouritism in the disbursement of the fund. Inname, who spoke to one of our correspondents on the phone, claimed that Sokoto State was among the first set of states that fulfilled the conditions for accessing the fund. “We are among the first set of states that fulfilled the requirements for accessing the fund but, I don’t know how and why Sokoto is included among the 14 states the minister mentioned. “We have met all the conditions which included forwarding our application, opening of a dedicated account with the CBN and passing the primary health insurance bill into law.
“A case in point is Katsina State that only passed its health insurance bill into law, I think about a month ago and was included among the beneficiaries whereas, we passed our law as far back as early 2018, but we are not included. “They earlier said the selection would be in batches. I don’t know the criteria they adopted in their selection, only for them to be accusing us of not showing interest in the programme. “We are not opposed to the programme. We are seriously interested in it for the benefits of our people, and that is why we do everything possible to meet the conditions for participating in the programme,” he stated.
Taraba didn’t oppose BHCPF – Commissioner
Also, the Taraba State Commissioner for Health, Dr Innocent Vakkai, said the state government did not oppose the BHCPF. Vakkai in a telephone interview with one of our correspondents said the state government was making efforts to join the scheme as soon as the procedures were completed.
Akwa Ibom has fulfilled all conditions – Commissioner
However, the Commissioner for Information and Strategy, Mr Charles Udoh, said the Akwa Ibom State Government had fulfilled all the conditions for the disbursement of the fund. He said, “Akwa Ibom State has fulfilled all these conditions and we are only waiting for the funds to be disbursed.” Udoh however denied that the state government had abandoned the health sector.
We may sue FG, says Ogun
But the Ogun State Commissioner for Health, Dr Babatunde Ipaye, said the state government could sue the minister and the Federal Government over the fund. He said the state government had not taken the Federal Government and the minister to court because they were in the same political party, the All Progressives Congress. The commissioner said, “The truth is that we have a conflict on it. We have written an application because there is a problem in the modus operandi. “It is not supposed to be a principal/student relationship. The fund is from the Federation Account, every state is systematically entitled to it.
“I have told him (the minister) that if he takes it too far, some of us will challenge him in court. He is bringing some conditions that will shortchange us. We have been keeping quiet because we are part of this present government. “The Federal Government cannot sit there and be acting like a judge on the money that is supposed to belong to everybody. And if it takes it too far, we will just go to court because whatever Ogun State is entitled to should be given to Ogun State. “Why will they be coming to tell us that one state has more problems than another state? They will now give huge amount of the money to the governor in that state. “If not that we are in the same party, we would have challenged him in court and if they are deducting such money, it means they are deducting money from every state. Why will you now say that one state should get larger percentage than the other?”
Minister is right but health remains our priority – Borno
However, Dr Salisu Kwaya-Bura, the Borno State Commissioner for Health, said the minister was right. He said, “The health minister is probably right. The state did not fail to show interest but perhaps such an expression was late. “Considering our challenges in the state, we cannot shy away from such an opportunity as health care remains our topmost priority. Certain challenges hindered the state from submitting our letter earlier than we did but now that has been done.”